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Friday, November 30, 2018

How many times in your life have you
thought or said “knowledge
is power”.Knowledge is a
powerful factor that empowers people to achieve great results. The more knowledge a person gains,
the more powerful he or she becomes.It’s especially true when conducting outbreak investigations.The more we investigate and uncover the more
we can understand what happened or is happening and the better we can resolve
the issue and put safe guards in place to avoid similar occurrences in the
future.

The unfortunate part of this is that the
knowledge we gain is after a set of unfortunate events where patients have
gotten sick, or even worse, died.Part
of our quest for knowledge needs to consider the unobvious.I would hazard a guess that our protocols or
standard operation procedures and our training programs could be vastly
improved if we looked beyond the obvious and the merely obvious.Children learn by experiencing their
environment.They’re curious, they touch
and get into everything.As we grow and
learn, we start to believe we know everything.Many of us stop being curious.

What if we went into a patient room, or
whatever room at whatever healthcare facility we work at and were as curious as
kids?How would you experience the
room?What would you look at?What would catch your eye?What if we touched and/or picked up every
item in the room, looked at it in detail and asked ourselves how would it cause
or could it cause and HAI?Do you think
our knowledge of what could or could not possibly cause an HAI change?Or are you wondering why I am asking so many
questions?

The reason for my curiosity is due to a
study I read that was published in the October volume of ICHE the study discusses
transmission of HCV in a liver transplant center.The result of the investigation lead the
researchers to conclude that the cause of the transmission was from a reusable
blood collection tube holder that was not disinfected between uses.During the course of the investigation, 34
environmental samples were taken from the inner and outer surfaces of 14 tube
holders, a glucometer tray, a tray used for phlebotomy, and a phlebotomy
trolley.The virus was only found on the
inner surface of 1 of the 14 tube holders.The researchers postulate that rapid removal of vacuum-specimen tubes
from the sleeved-needle can be followed by a fine splash that then contaminates
the inner surface of tube holders.Additionally, during removal of the double ended needle, the inner
surface of the tube holder can also become contaminated.

The authors identified several limitations
to the study, however, they also identified an unobvious way that HCV could be
transmitted. They concluded that single-use disposable tube holders are
preferable to not only prevent needlestick injury but to ensure that we
minimize any possible transmission of HAIs.

Regardless of the situation, I hope you’ll
consider acting like a child, be curious and explore your world looking for all
of the unobvious ways HAIs can be transmitted!

Friday, November 23, 2018

I think I’ve mentioned before, while I love
dressing up and have a bit of a shoe fetish, I’m not a girly girl.Growing up on a farm, playing in the barn,
riding horses and playing piano meant that my finger nails were not generally a
focus.The same holds true to this
day.I am generally a naked, short nail
girl, but upon occasion I enjoy a manicure and pretty painted nails.

This week happens to be one of those rare
occasions.I decided to pamper myself
with a mani-pedi.I went for shellac on my finger nails.It’s harder and lasts longer.The problem is that it’s thicker so those tasks you use your
finger nails for, like picking popcorn husks out of your teeth, become
impossible leaving you suffering with a husk stuck between your teeth or
searching around while muttering under your breath looking for the dental
floss.

Why am I telling you my woes?Well, I just received my latest copy of the
Journal of Hospital Infection and came across an article “Nail
microbial colonization following hand disinfection: a qualitative pilot study”.We know that healthcare worker (HCW) hand
hygiene is one of the key measures to minimize HAIs.The study investigated the microbial
colonization of nails taking into consideration the nail length and the
presence or lack thereof of nail polish.The study included 99 HCW (nurses and midwives), 45 of which had natural
nails, 44 had varying types of nail polish and of the 99, 40 had long
nails.Of interest, HCWs who worked in
the surgical units were among the highest to have nails with some form of
polish.There was also a correlation
between the length of the nail and the use of nail polish – the longer the nail
the more likely it was to have nail polish on it.After following proper hand hygiene, the
researchers found that the presence of potentially pathogenic microorganisms
was correlated with nail length. Also, when HCWs kept longer nails that had
UV-cured nail polish (aka shellac) there was a high probability of ineffective
hand hygiene being performed.

While most healthcare
facilities have policies around the use of nail polish, it is also
well known that policing of such policies is not always done.While short, naked nails are preferred and
proven to be the easiest to disinfect, this study shows that even if nail
polish is used, shorter nails are more important when it comes to performing
effective hand hygiene.The study also
highlights that UV-cured polish needs to be banned.

Not being a routine polish wearer, I would
advocate for short nails and no polish when it comes to HCWs.However, I think I may also expand this to
include service providers such as waitresses, chefs, daycare providers, aestheticians
etc.Why?Well, if a HCW who has been trained time and
time again about the importance of hand hygiene and how to properly perform it
cannot keep their long, painted nails free of infection causing bugs then what
would we expect to find under the long, painted nails of people who have not
had hand hygiene training?

As for me, I’ll keep my UV-cured polish on
my nails for the next several weeks, but you can be sure they will be kept
short and I will be scrubbing extra hard to keep them clean!

Friday, November 16, 2018

As I drove home from work tonight I was thinking how dark it
was at 5:30pm – I’d been inside all day.
I hadn’t seen much sun. To make matters worse, my drive home that
normally takes 15 – 20 minutes took 40.
It’s the first big snow of the year and much to my dismay, 4 hours later
it’s still snowing. Many love the first blanket
of snow. Those that love it are probably
not the ones driving home during rush hour where everyone has forgotten how to
drive, and the cloud cover was heavy making it particularly dark. Tonight I was lucky. The car behind me, not so much. I witnessed a car slide into them from my
rear-view mirror. As I was watching, I
moved forward to avoid being the 3rd vehicle in a chain reaction.

Why the talk about doom and gloom?Well, according to researchers
from the University of Oregon in dark rooms more bacteria was found
to be alive and able to reproduce (e.g. viable and potentially infectious) as
compared to rooms that were exposed to sunlight or even UV light.Let’s be honest.Many of us spend an inordinate amount of time
indoors, particularly in the colder months.The more time we spend indoors, the more time we are exposed to dust
particles trapped inside with us and the bacteria that may be hiding in the
dust.

The researchers found that dust that was kept in the dark
contained microbes that were closely related to species associated with
respiratory diseases and that these microbes were absent in dust exposed to
daylight. They also found that a larger proportion of the bacteria found were
outdoor air-derived bacteria, indicating that the microbiome of indoor dust
exposed to daylight makes it resemble bacterial communities found in the great
outdoors.

The study would suggest that the long held belief that sun
is good for our health is true. Contemplating the design of
buildings such as schools, offices, hospitals and homes in a way to allow as
much natural light coming in as possible may reduce the risk of dust-borne
infections. It also highlights the importance for routine cleaning and
disinfection. As we now know that dust carries infectious pathogens and that
the darker the space the more concentrated the bacteria is, we may want to
rethink our cleaning programs as well.Do we need to increase the frequency of dusting areas that we may touch
on only a weekly or even monthly basis?As the dust accumulates so too does the concentration of pathogens.Air movement can move the dust which may lead
to transmission of infections.

Friday, November 9, 2018

This year seems to be particularly bad for colds and other
viruses.We’ve had a couple of different
viruses running through our office and I should have stocked up on “Kleenex”
based on the amount my son has gone through since heading back to school in
September!I have a virus.It’s just a cold.I feel crappy, but I’ll push through it
because isn’t that what good moms, wives and employees do?If you’ve read some of my previous blogs you
may recall that I also believe if I can pass my cold on to one other person I instantly start feeling better.Anyone want a hug?

The million dollar question is, how did I get it? Who knows,
but after reading a recent study looking at fomite-mediated
transmission of viruses I’ve come to the conclusion they can come
from anywhere and everywhere.The study
looked directly at fomite transmission (direct shedding onto a fomite) and
hand-fomite transmission (shedding onto a hand that then touches a fomite) of
influenza, rhinovirus and norovirus.The
researchers concluded that both rhinovirus and norovirus direct fomite
transmission is definitely a route of transmission whereas influenza did not
show the same capability.The
hand-fomite route was shown to be more relevant for rhinovirus and influenza
transmission. For norovirus, ability to transmit via the hand-fomite route
versus the direct fomite route was dependent upon the amount of norovirus
initially shed onto the hands.

Understanding the impact of the route of transmission helps
to determine the most effect intervention to implement.For influenza, increasing the frequency of
environmental surface disinfection will help to prevent outbreaks. This is due to
the fact that influenza demonstrated the lowest fomite reproductive
number.Conversely, rhinovirus and
norovirus are so infectious that a single environmental intervention is
unlikely to stop their spread via fomites.

I guess if I want to start feeling better I had best start
spreading my germs directly to fomites and of course, stop washing my hands to
make sure they have the best chance possible to transmit to every surface I
touch because “sharing is caring”!

Friday, November 2, 2018

I always thought that cleanliness was next to
godliness.When it comes to bathing
however, I firmly believe there are two camps.Those who like to lounge in a tub pretending to relax by reading a book
while the bubbles dissipate, the water turns cold and you lay in your own filth,
and then there’s those who do not find standing onerous and love the feeling of
hot water spraying over their body.I am
firmly in the shower camp.I try to
enjoy a good bath, but truth be known, after 5 minutes I’m bored or I’ve gotten
so hot that I’m sweating and need to take a shower to cool down.The same can be said for me in hot tubs….After reading a recently published study
done by researchers at the University of Colorado Boulder, I may have to rethink
how I bathe and contemplate bathing as opposed to showering.Well, at least in some parts of the USA.Researchers found that the prevalence of
pathogenic mycobacteria in showerheads correlated to regions where
nontuberculous mycobacterial (NTM) lung infections are most common.It’s not unknown that bacteria thrive in
showerheads and throughout household water distribution systems.Generally, we have nothing to worry about,
however upon occasion the type of bacteria found can lead to infections.The researchers surveyed showerheads in
households across the USA and found that the bacterial population differed by
region and the type of water.Surprisingly, households supplied with chlorinated treated water had
higher levels of some types of mycobacteria.Truth be known, we
shouldn’t be surprised that showerhead biofilm can lead to infections. At
least, I would hope not.Most deaths
from Legionnaires' disease are tied to hospital and nursing home showers
according to a 2015
report by the CDC.

If you’re concerned
about your shower water quality, the five regions identified in the study are
Hawaii, Florida, The upper Midwest, Southern California and The Mid-Atlantic
States.Lucky me, I just spent 3 nights
in Maryland in a hotel where, let’s just say, it was in a serious need of a
facelift and based on the inconsistent shower spray, they do not have a
cleaning and disinfection protocol to clean their shower heads.I guess I’ll just wait and see if I get sick!